Iron deficiency isn’t always as simple as low iron stores. Some people struggle with low circulating iron despite high ferritin levels, which often points to inflammation, poor iron metabolism, or underlying gut issues.
If you've ever had a blood test showing high ferritin but still feel exhausted, weak, or iron-deficient, this is a sign that iron isn’t being used properly by the body.
Understanding Ferritin vs. Iron
Ferritin is the storage form of iron—it’s what the body locks away for later use. But just because ferritin is high doesn’t mean your iron levels are sufficient.
Common Patterns I See in Clinic:
✔ Low iron, low ferritin – Classic iron deficiency, often due to low intake, poor absorption, or heavy periods.
✔ Low iron, high ferritin – This suggests inflammation is blocking iron usage, common in conditions like endometriosis, autoimmunity, or chronic infections.
✔ High iron, high ferritin – Can indicate iron overload, which may need to be managed carefully, especially in conditions like haemochromatosis.
✔ Normal iron, low ferritin – Could be an early-stage deficiency, especially if someone has been under stress or had recent blood loss.
If your ferritin is high but you still feel iron deficient, it’s time to look deeper at what’s causing the issue.
High Ferritin but Low Iron: What’s Causing the Problem?
1. Inflammation is Blocking Iron Usage
When inflammation is high, the body traps iron in storage (ferritin) to keep it away from bacteria and pathogens. This is a protective mechanism, but it also means iron isn’t available for red blood cell production and energy metabolism.
This happens in conditions like:
-
Autoimmune diseases (Hashimoto’s, rheumatoid arthritis, endometriosis)
-
Chronic infections (including gut infections like SIBO or H. pylori)
-
Metabolic disorders and insulin resistance
-
High stress and cortisol dysregulation
The more inflammation and oxidative stress, the more likely iron will be stored instead of used.
2. Gut Dysfunction & Dysbiosis
Even if you’re eating plenty of iron-rich foods, gut issues can block absorption and contribute to iron dysregulation.
Common gut issues affecting iron metabolism:
-
Leaky gut & dysbiosis – Increased gut permeability can trigger immune activation and iron sequestration.
-
Pathogenic bacteria overgrowth – Some bacteria consume iron before your body can absorb it, leading to ongoing deficiency.
-
H. pylori infections – This bacteria reduces stomach acid, making it harder to absorb iron properly.
If gut issues are present, iron won’t be absorbed efficiently, no matter how much you supplement.
3. Liver Health & Iron Regulation
The liver plays a critical role in iron metabolism and detoxification. If the liver is overburdened with toxins, medications, or excess inflammation, iron storage and usage can be affected.
-
Poor liver function can lead to impaired iron metabolism and increased ferritin.
-
The liver also helps clear excess iron, preventing oxidative stress.
If someone has a history of poor detoxification, sluggish digestion, or hormone imbalances, supporting the liver is key to fixing iron imbalances.
What to Do if Ferritin is High but Iron is Low
If this pattern shows up in blood tests, simply adding more iron won’t fix the issue. Instead, the focus should be on:
1. Lowering Inflammation to Improve Iron Usage
-
Reduce inflammatory foods like processed sugar, seed oils, and dairy.
-
Increase omega-3s, turmeric, and polyphenols to lower oxidative stress.
-
Check for and address any underlying infections or autoimmune issues.
2. Supporting Gut Health for Better Iron Absorption
-
Use Lactobacillus plantarum 299v, a probiotic shown to improve iron absorption.
-
Support stomach acid with apple cider vinegar or digestive bitters before meals.
-
Consider gut testing if bloating, reflux, or IBS symptoms are present.
3. Optimising Liver Detoxification
-
Increase cruciferous vegetables like broccoli, kale, and cauliflower to support iron metabolism.
-
Use milk thistle and dandelion root to support bile flow and detoxification.
-
Stay hydrated and support lymphatic drainage through sauna or dry brushing.
4. Choosing the Right Form of Iron
If iron supplementation is still needed, avoid ferric iron and opt for:
-
Ferrous bisglycinate – Gentle and well-absorbed.
-
Lactoferrin – Supports iron metabolism without increasing inflammation.
-
Heme iron supplements – If dietary intake is low.
Avoid taking iron with calcium or high-tannin foods like tea and coffee, as these block absorption.
Iron Overload: When Too Much Iron Becomes a Problem
While iron deficiency is common, too much iron can also be harmful.
Iron is a double-edged sword—while necessary for energy production and oxygen transport, excess iron contributes to:
-
Oxidative stress and DNA damage
-
Increased inflammation and metabolic dysfunction
-
Microbiome imbalances, as certain bacteria thrive on excess iron
People with genetic conditions like haemochromatosis or metabolic dysfunction need to be careful with iron intake.
Signs of Iron Overload:
-
Fatigue, joint pain, and liver issues
-
High ferritin but normal or high iron saturation
-
Poor glucose metabolism and insulin resistance
If iron overload is suspected, blood donation can help lower iron stores safely, but proper assessment is key before taking action.
Iron, Hormones, and Women’s Health
For women, iron metabolism is closely linked to hormonal balance and menstrual health.
-
Heavy periods deplete iron quickly, making regular testing essential.
-
Oestrogen metabolism affects iron levels, as high oestrogen can influence ferritin storage.
-
Low progesterone or chronic stress can increase inflammation, blocking iron absorption.
For women with endometriosis, PCOS, or hormonal imbalances, managing iron means looking beyond supplements and addressing the bigger picture—hormones, inflammation, and gut health.
When to Test and What to Look For
If you’re unsure about your iron status, a comprehensive blood test is essential.
Key markers to check:
-
Serum iron – Measures circulating iron.
-
Ferritin – Reflects stored iron.
-
Transferrin saturation – Shows how much iron is available for use.
-
CRP & inflammatory markers – High levels suggest iron is being trapped due to inflammation.
-
B12 & folate – Essential for red blood cell production.
If ferritin is high but iron is low, simply taking more iron won’t work. The goal is to reduce inflammation, fix gut health, and optimise iron metabolism naturally.
Struggling with Iron Issues? We Can Help
Iron imbalances are complex, and one-size-fits-all solutions rarely work. Whether you’re dealing with persistent iron deficiency, poor absorption, or high ferritin with low iron, the key is identifying and addressing the underlying cause.
At Her Earth Medicine, we take a functional approach to iron health, looking beyond simple supplementation and addressing:
-
Why your iron isn’t increasing despite supplements.
-
How inflammation or gut health is affecting iron absorption.
-
The best way to support long-term iron balance safely.
If you’re waiting for an appointment, start by:
-
Checking inflammatory markers if your ferritin is high but iron is low.
-
Supporting gut health with the right probiotics and digestive support.
-
Avoiding iron forms that cause inflammation and focusing on absorption.
If you're ready for a personalised iron plan, book a consultation at Her Earth Medicine and get your iron levels back on track.